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Credit Card Deposits

I am placing a $500 non-refundable deposit for an incoming vehicle.

I am aware of this charge and understand that a copy of my receipt will be provided to me.

I
understand that a refund will be given only if Chiefland Chrysler Dodge
Jeep Ram fails to deliver the vehicle as discussed and agreed or if the
vehicle does not arrive in proper condition for delivery (damage to
vehicle).

I also understand that if there is a trade-in involved
in this transaction and the new vehicle takes over 30 days to arrive,
the trade-in will have to be re-evaluated at the time of delivery.

Please complete this form then click Submit.

Chiefland CDJR Credit Card Deposit Form*

I have read, understand and agree to these conditions and give Chiefland CDJR authorization to charge my credit card.*

Yes

No

Please charge my credit card in the amount of... (if no amount is specified, the standard amount is $500.00).*

Stock number of vehicle (last 6 digits of the VIN):*

First Name:*

Last Name:*

Email Address:*

Credit Card Number:*

Expiration Date:*

Security Code (3 digits; 4 digits if American Express):*

Billing Address*

City:*

State:*

Billing Zip Code:*

Best Phone Number to Contact You:*

Driver's License Number:*

Issuing State:*

By submitting your contact information, you consent to be contacted by telephone about purchasing a vehicle or obtaining vehicle financing. Clicking on the Submit button above is your electronic signature.